In the Netherlands a new and countrywide routine screening system for physical congenital anomalies was introduced by legislation in 2007. The screening was aimed initially at Down syndrome, but under specific conditions secondary screening for cleft lip and palate and other congenital malformations is performed as well. This article gives an overview of the Dutch system, with a focus on cleft lip (and palate) and the report of one center's experience. In general, voluntary termination of pregnancy in the second trimester has increased slightly since the introduction of the current system, but the termination-of-pregnancy rate for isolated cleft lip and palate remains limited in the Netherlands.